[en] Introduction
Although average injury rates are decreasing, large inequalities continue to exist between countries within the European Union. Mortality rates from injury for children aged 0-19 in Lithuania in 2014 were 19/100,000 whereas in Spain the rate was 4/100,000. Within countries the picture is mixed and children’s injury risk is related to factors such as their socio-economic status or the education level and employment status of their parents. The impact of these factors means that important inequalities exist within countries in localised pockets of poverty and deprivation but also in wealthy areas.
Better prevention of child injury is thus needed; however, it is a multi-sectoral undertaking. Risk factors are multi-faceted: social, environmental, and economic. Responsibility for controlling these risk factors transcends traditional policy sectors. Child injury prevention also occurs at multiple levels of governance; from local action to initiatives at international (European or global) level. Furthermore, injury prevention requires participation from the public and private sector and from civil society.
This thesis explores the space between research and practice in the field of child safety in Europe. The research focuses upon the challenges for decision makers to analyse their local situation, choose interventions and put them into practice.
Method
The thesis focuses on four domains of child injury: road; water and home safety; and intentional injury prevention. Data collection for Chapters Three, Four and Six occurred between 2011 and 2014 within the framework of the EU-funded project; ‘Tools to Address Childhood Trauma and Children’s Safety’ (TACTICS). Participants were also involved in the TACTICS project and came from 27 countries of the WHO European Region. Chapters Two and Five are based on literature reviews conducted outside the framework of the TACTICS project.
The theoretical underpinning of the thesis is based first: upon the Public Health Approach to injury prevention from Sleet et al., that underlines the importance of both an evidence-based approach and evidence-based practice within injury prevention. Second: the governance for
health framework by Kickbusch and Gleicher which proposes the whole-of-government and whole-of-society approach to effective health governance. Third: the six stages of implementation proposed by Fixsen et al., theoretically guides the process of implementation.
A combination of research methods was used throughout. Literature reviews guided the direction of the thesis and informed the content of the models and tools proposed. Quantitative and qualitative data was generated to identify the different sectors implicated in child injury prevention. A public health ethical framework was applied to an existing child safety intervention to explore ethical considerations. Finally, qualitative data was analysed using thematic content analysis to explore the process of implementation.
Results
A practical tool for use at the local level to address the cross-cutting nature of child injury prevention was developed. The tool is based on Haddon’s matrix and takes a life-course approach to injury prevention. It was developed for use by multi-sector stakeholders at the local level to better understand the complexity of child injury and develop multi-sectoral solutions.
Twenty-seven different policy sectors were found to be implicated in child safety. Of these 27 sectors nine sectors were identified as ‘core’ sectors:
Education;
Health;
Home Affairs;
Justice;
Media;
Recreation;
Research;
Social/Welfare Services;
Consumers
Core sectors were considered applicable across the whole of child safety.
Child safety reference frameworks (CSRF) were developed for use at the sub-national level.
CSRF, can be used to inform policy makers about possible evidence-based child safety interventions, to assess the state of affairs in the region and to compare the situation regionally, nationally, internationally or over time.
An ethical assessment of an intervention for child safety in the home highlights the relevance of public health ethics to child safety interventions.
A thematic content analysis of facilitators and barriers for the adoption, implementation and monitoring of child safety interventions resulted in the identification of eight themes found to be applicable, to a varying degree, throughout the three phases of the process:
Management and collaboration;
Resources;
Leadership;
Nature of the intervention;
Political, social and cultural environment;
Visibility;
Nature of the injury problem;
Analysis and interpretation.
Conclusion
The findings demonstrate the multi-sectoral nature of child injury prevention and the challenges of implementation within an issue of such complexity. With a greater uptake of interventions it is hoped that the inequalities between and within countries could be reduced. The findings and tools presented in this thesis may help stakeholders at the local and regional levels to take action to protect children from injury.